Management of the Toddler's fracture with and without initial radiological evidence

Area of Science:

• Pediatric Orthopedics
• Pediatric Emergency Medicine
• Radiology

Background:

• Toddler's fracture (TF) is a common injury in young children following minor trauma.
• Diagnosis can be difficult, and initial X-rays may not show clear evidence of fracture.
• Management strategies for clinically diagnosed TF with and without radiological confirmation require comparison.

Purpose of the Study:

• To compare the management and outcomes of toddler's fracture (TF) in children aged 9-36 months.
• To evaluate the significance of initial radiological evidence versus presumptive clinical diagnosis in TF management.
• To assess the impact of radiological confirmation on treatment decisions and patient outcomes.

Main Methods:

• Retrospective cohort study design.
• Inclusion of patients aged 9-36 months treated for TF in a Scottish Paediatric Emergency Department.
• Comparison of management (casting) and outcomes (duration of cast, time to discharge) between radiologically confirmed and clinically diagnosed TF groups.

Main Results:

• Patients with radiologically confirmed TF were significantly more likely to be treated with a cast (92%) compared to those with presumptive clinical diagnosis (47%; P<0.02).
• Overall cast duration and time from follow-up to discharge were similar between the two groups.
• No complications were reported regardless of casting status.

Conclusions:

• A presumptive clinical diagnosis of toddler's fracture (TF) can be as significant as radiological confirmation.
• Follow-up imaging is unlikely to alter management decisions if the clinical diagnosis of TF remains clear.
• Current management approaches for TF appear safe and effective, irrespective of initial radiological findings.